Neuromodulation medical treatment device

ABSTRACT

The present disclosure provides a neuromodulation medical treatment device and a medical treatment neuromodulation method for stimulating peripheral nerves. The device comprises a pulse generator and at least one active electrode connected to the pulse generator. The at least one active electrode has an electrically conductive surface of less than or equal to 0.3100 square inch and the electrically conductive surface is attachable to a patient&#39;s skin in a proximity of branches of peripheral nerves. The at least one active electrode is adapted to stimulate via the electrically conductive surface the peripheral nerves by electrical pulses generated by the pulse generator. The control unit controls the pulse generator and sets at least one parameter of generated electrical pulses.

TECHNICAL FIELD

The present disclosure relates to a neuromodulation treatment device anda medical treatment neuromodulation method for a stimulation of neuronsin a patient's body.

BACKGROUND OF THE INVENTION

A medical use of electrical stimulation of neurons to benefit a humansubject has been used to treat incontinence, to stimulate muscles forthe purpose of simulating exercise and subsequent increase of heartrate, to improve lymphatic drainage of the lower limbs, to stimulateneurons, and for other related applications associated with positiveeffects of electric current.

One example of a stimulation method known as a percutaneous tibial nervestimulation (PTNS) method is utilized for treating incontinence. ThePTNS method uses a needle introduced in close proximity of the nerve inthe ankle region, and by means of an electric current connected thereto,it stimulates the nerve as well as the adjacent nerves in the pelvicarea. Such repeated stimulation of the pelvic region can have asignificantly positive effect on both the functioning of muscles and thecommunication between the patient's body and nervous system. Improvementof a bladder function by a nerve stimulation using an electrical currentdelivered to the proximity of the nerve via a body invasive needle maybe achieved by repeated sessions each lasting several minutes. Thehistoric disadvantages of inserting needles into the patient's bodyinclude mainly pain, the risk of infection and nerve damage, and also arequirement of a medical professional to carry out the treatment.Additionally, for a successful treatment, it is important to ensure anaccurate targeting of the nerve to be stimulated. In practice, thesubjective feeling of the patient is used. However, this is not alwaysaccurate, and it has proven to be the biggest obstacle in impactingsuccess rates of the treatment. Therefore, there is a need for aneuromodulation medical device and a medical treatment method utilizinga stimulation electrode suitable for a placement to a skin of thepatient's body and capable to stimulate target nerves.

SUMMARY OF THE INVENTION

An aspect of the present disclosure provides a neuromodulation medicaltreatment device for stimulating peripheral nerves, comprising a memoryunit, at least one electrode attached to the patient's body forgenerating pulses, a control unit connected to the electrode for settingat least one electrode pulse parameter, and further connected to atleast one response detector to neuromodulation. The response detector toneuromodulation is connected to a control unit for transmittinginformation on the frequency of movement of at least a part of thepatient's body. The control unit of the device further sets the flow ofcurrent of electrode pulses automatically, depending on informationabout the frequency value of movement of at least a part of thepatient's body.

More particularly, an aspect of the present disclosure provides aneuromodulation medical treatment device for stimulating peripheralnerves comprising an optional memory unit, a pulse generator configuredto generate electrical pulses, at least one electrode connected to thepulse generator, the at least one active electrode has an electricallyconductive surface of less than or equal to 0.3100 square inch and theelectrically conductive surface is configured to be attached to apatient's skin. The neuromodulation medical treatment device furthercomprises a control unit that may be connected to the at least oneelectrode. The control unit is configured to control the pulse generatorand set at least one parameter of the generated electrical pulses. Thecontrol unit is further configured to adjust the at least one parameterof generated pulses. The control unit may be further connected to anoptional at least one response detector to neuromodulation. The responsedetector to neuromodulation may be connected to a control unit fortransmitting information on the frequency of movement of at least a partof the patient's body. The control unit of the device further may setthe flow of current of electrode pulses automatically, depending oninformation about the frequency value of movement of at least a part ofthe patient's body.

The control unit may receive information on the frequency value from theresponse detector to neuromodulation, or from memory. The detector ofthe device can be an optical sensor, an infrared sensor, anaccelerometer, or a capacitive, inductive, thermal, flow, ultrasound, ormagnetic sensor. In an alternative embodiment of the present disclosure,an electromyograph can also be used as a detector. In a preferredconfiguration, the detector can make use of more than one sensor.

The memory device can be at least one of the following: an HDD disk, SSDdisc, flash memory, memory card, RAM, CD, DVD, or Blu-ray. Inalternative configurations, the memory can be a remote storage deviceaccessible through a network service.

Alternatively, the remote memory storage unit can be accessible throughanother neuromodulation device connected to the network service.

The control unit may change the frequency of the electrode pulses untilit substantially equals the frequency of the recorded movements. Thecontrol unit may also change the flow of the current of pulses until theoptimum frequency of recorded movement is reached.

The device can include one or more control units, which are separated.The control unit can be a part of the controller, which may furthercomprise a display device and user input for the operator. The controlunit, according to the present disclosure, sets the frequency of thepulses in a range between 0.1 and 100 Hz and sets the length of thepulses in a range between 0.1 and 10 ms. The control unit, as per thepresent disclosure, may further set the shape of the pulse. The controlunit of the present device may further set the polarity of the voltageranging from positive to negative.

The control unit may communicate with a database stored in the memory,which is the internal memory of the control unit, or in a remote storageunit, available via network services. Here it may store the informationon recommended parameters of the flow of the current of pulses. Thedatabase may further include the patient's personal data, such as butnot limited to: information on the patient's age, sex, information onidentity and personal data of the patient, for example identificationnumber, number of the insurance, address, social security number, creditcard number and so on. As per the present disclosure, the control unitmay send the information from the database to the remote storage. As perthe present disclosure, the detector and the controller may be parts ofa single construction. In one aspect, the controller and at least one ofthe electrodes may be parts of a single unit. Such single unit can be adevice electrically and mechanically connected. In some aspects, asingle unit may be also integrated in a single construction.

A further aspect of the present disclosure provides a medical method fora neuromodulation treatment that may include treatment of symptoms of anoveractive bladder and/or fecal incontinence in humans. The method mayinvolve a control unit and at least two active electrodes capable ofgenerating electrical pulses. The at least two active electrodes may beattached to the patient's body, so that a first active electrode of theat least two active electrodes is attached to either of the patient'slegs and a second active electrode of the at least two active electrodesis also attached to either of the patient's legs. The first activeelectrode of the at least two active electrodes may be attached to afirst patient's leg in the back of the knee area in proximity of aperoneal nerve of the first leg. The second active electrode of the atleast two active electrodes may be attached to a second patient's leg inthe back of the knee area in proximity of a peroneal nerve of the secondleg.

Alternatively, the first active electrode may be attached to the firstleg of the patient and the second active electrode is also attached tothe same leg. The first active electrode may be attached to the back ofeither knee and the second active electrode is attached to the back ofthe other knee.

After the active electrodes are attached, the first electrical pulses inthe first active electrode may be delivered to the patient's body, andat the same time or subsequently, other electrical pulses in the secondactive electrode may be delivered to the patient's body. In thefollowing step, the flow of the pulse current may be set. The preferredmethod further involves a step of synchronizing the timing of eachpulse.

In one aspect the active electrodes are attached in the proximity ofbranches of a peripheral nerve.

The active electrodes may be attached to the patient so that the firstactive electrode may be attached to the first branch of the sciaticnerve and another, second, active electrode may be attached to anotherbranch of the sciatic nerve. Preferably, one of the following nerves isstimulated: the lumbosacral plexus, sciatic nerve, common peronealnerve, tibial nerve, pudendal nerve, superior gluteal nerve, inferiorgluteal nerve, posterior cutaneous femoral nerve, obturator internusnerve, piriformis, quadratus femoris nerve, plantar nerve, coccygealnerve. In preferred embodiment, pudendal nerve or tibial nerve or commonperoneal.

In one aspect, the first active electrode may be attached to one leg ofthe patient and the second active electrode may be attached to the otherleg of the patient. In another aspect of the present method, the firstactive electrode may be attached to the first leg of the patient and thesecond active electrode is also attached to the same leg of the patient.

The active electrodes are, according to the present disclosure,transcutaneous, percutaneous or electrodes for long term implantation.In one aspect of the present method, the first active electrode may beattached to the back of either knee and the second active electrode maybe attached to the back of the other knee. Synchronization of theelectrical pulses delivered to patient via the first and the secondactive electrodes may be achieved by timing the pulses to beginning ofeach pulse. The timing of pulses may be synchronized per the time ofdelivery of the pulse from the first active electrode and the time ofdelivery of the pulse from the other active electrode into the targetarea. The target area may be a sacral plexus or a sciatic nerve. Themethod, further involves placing a grounding electrode onto thepatient's body, most advantageously on the patient's suprapubic,hypogastric or sacral area.

The electrical pulses may have, a frequency between 0.1 Hz and 100 Hz, apulse width between 0.1 ms and 5 ms, a current between 0 mA and 250 mAand a voltage between 0 V and 90 V. The frequency of the electricalpulses may be set between 2.5 Hz and 60 Hz and the pulse width ofelectrical pulses may be between 0.1 ms and 2.5 ms. Each of the activemay have an active surface greater than 0.3100 square inch (2 cm²), theelectrical pulses may have a current between 15 mA and 250 mA.Alternatively, each of the active electrodes may have an active surfacebetween 0.0775 square inch (0.5 cm²) and 0.3100 square inch (2 cm²), theelectrical pulses may have a current between 0 mA and 15 mA.Alternatively, each of the active electrodes may have an active surfaceless than 0.0775 square inch (0.5 cm²), the electrical pulses may have acurrent between 0 mA and 5 mA.

The electrical pulses may have substantially a rectangular orright-triangular shape and are monophasic or biphasic. The time of thepulses may be determined by an algorithm stored in the control unit'smemory.

The method may further include the following steps for a precisepositioning of the first and second active electrode. After attachmentof any of the active electrodes, the electric pulses are generated, andthen reflex movements of at least one part of the patient's body may bemonitored. The sufficiency of the reflex movements of the monitored partof patient's body may be determined. If the reflex movements of themonitored part of the patient's body are insufficient, the activeelectrode is repositioned. The steps may be repeated until the reflexmovements of at least one part of the patient's body are sufficient andthus the optimal location is found for the active electrode. The methodmay further include collecting information about the use of theneuromodulation medical device as described above, other similarneuromodulation devices or other medical devices. The method mayinvolves collecting information from the control unit. The informationmay be sent from the control unit to a memory. The information may bestored in a database. The information may be retrieved from saiddatabase. The medical device as describe above may be a therapeuticmedical device, a surgical medical device or a diagnostic medicaldevice. The control unit can communicate with the memory using any ofthe following means: GSM, Bluetooth, radio frequency, infraredcommunication, LAN, USB or a wireless internet connection. The methodmay further involve assigning an identification number to a patient,medical device or the information. The method may further involve stepsof storing the information in the memory of the device and connectingthe medical device to another medical device. The information mayconcern an undergone treatment and involve at least information on thepulse current flow, current intensity, the frequency of pulses. Themethod may further involve evaluating the information stored in thedatabase and may use said information for invoicing. The method mayfurther involve using the information stored in the database and sendthe information to the patient's physician and/or to the patient'selectronic medical chart. The method may further involve using theinformation stored in the database to automatically alter the parametersof the treatment or use of the device.

BRIEF DESCRIPTION OF THE FIGURES

Other features and advantages of the disclosure appear from thefollowing detailed description of some of its embodiments, given by wayof non-limiting example, and with reference to the accompanyingdrawings, in which:

FIG. 1 shows a side view of the first embodiment of the electrode.

FIG. 2 shows a bottom view of the first embodiment of the electrode.

FIG. 3 shows a magnetic field emitted by the first embodiment of theelectrode.

FIG. 4 shows a side of an alternative embodiment of the electrode.

FIG. 5 shows whole device as per the present disclosure.

FIG. 6 shows an assembly of the optical sensor in the detector.

FIG. 7 shows an assembly of the ultrasonic sensor in the detector.

DETAILED DESCRIPTION

The foregoing summary, as well as the following detailed description ofcertain examples will be better understood when read in conjunction withthe appended drawings. As used herein, an element or step recited in thesingular and proceeded with the word “a” or “an” should be understood asnot excluding plural of the elements or steps, unless such exclusion isexplicitly stated. Further, references to “one embodiment” are notintended to be interpreted as excluding the existence of additionalembodiments that also incorporate the recited features. Moreover, unlessexplicitly stated to the contrary, embodiments “comprising” or “having”an element or a plurality of elements having a particular property mayinclude additional elements not having that property.

In the figures, the same references denote identical or similarelements, unless stated otherwise. In the drawings, the size of eachelement or a specific portion constituting the element is exaggerated,omitted, or schematically shown for convenience and clarity ofdescription. Thus, the size of each component may not entirely reflectthe actual size. In the case where it is judged that the detaileddescription of the related known functions or constructions mayunnecessarily obscure the gist of the present disclosure, suchexplanation will be omitted.

The present disclosure may include three major components, as shown inFIG. 5. The first component is a control unit 13, the second one may bea detector 14, and the third is an electrode 15. The electrode can be oftwo types. The first possible embodiment of the electrode is the oneshown in FIG. 4, which involves a magnet 3, a pole piece 4, the firstpole 1 of the electrode and the second pole 8 of the electrode. The roleof the magnet 3 is to increase the depth range at low stimulationcurrents. Together with the pole piece 4, it can linearize andconcentrate parabolic electric field lines in an axial direction aroundthe axis of the first pole 1 of the electrode. This substantiallyresults in a tunnel effect for direction of movement and concentrationof ions as carriers of electrical charges into the intercellular spaces.In this embodiment, the magnet 3 is permanent and has the shape of ahollow cylinder, with the first pole 1 of the electrode, for example ofcopper or brass, passing through its center. In the area of contact withthe skin, the first pole 1 of the electrode is preferably round andcoated with a layer of a suitable material, such as silver. The outercasing and the side of the permanent magnet 3 away from the skin aresurrounded by the pole piece 4 of diamagnetic material. From the sideaway from the skin, the first pole 1 of the electrode is threaded foraffixing a nut 6 and terminates with an adapter 7 for connecting thewire 2. Alternatively, the first pole 1 of the electrode is fixed incombination with a spring and the additional bottom part. The first pole1 of the electrode is unthreaded and has a stop edge matching at least apart of the additional bottom part, wherein the first pole 1 of theelectrode is fixed by a biasing spring member so that the spring membercreates a tension between the first pole 1 of the electrode and,directly or indirectly, the fixing element 5. Thus force is applied inbetween the stop edge of the first pole 1 of the electrode and at leasta part of the additional bottom part, resulting in fixing the first pole1 of the electrode. The annulus-shaped second pole 8 of the electrode issecured to a fixing element 5 while separated from the first pole 1 ofthe electrode by a gap or another insulator. Thus, it is a bipolarelectrode having the fixed position of the first pole 1 of the electrodeand the second pole 8 of the electrode. The magnet 3 is separated fromthe first pole 1 of the electrode by an insulator and possibly also byan air gap. The magnet 3 is oriented with its north pole facing thetissue. The first pole 1 of the electrode, the magnet 3, the pole piece4 and the second pole 8 of the electrode are made of materials intendedfor medical use, and are electrically insulated from each other, exceptfor the area of the magnet 3 pole being in contact with the pole piece.Also, the insulation is of biocompatible material, which is also able towithstand frequent sterilization and is preferably also waterproof.

Preferably, the magnet 3 can be in the form of an electromagnet. Using asuitable source 9, as obvious to those skilled in the art, by means of aadjustable magnetic excitation, it is possible to set the shape of thearea with the highest concentration of the charge carriers, i.e. a kindof a channel. Moreover, if several electromagnets are used, by means oftheir different excitations, it is possible to affect the direction ofelectric current flow to the tissue, i.e. direction of such a channel.As an example, this can be used for finding the desired nerve, even inthe event of inaccurate placement of the electrostimulation device tothe skin.

The DC source 9 is connected between the first pole 1 of the electrodeand the second pole 8 of the electrode. The frequency can be set between1 to 15 Hz and the pulses can be monophasic or biphasic, and forexample, rectangular, sinusoidal or triangular, with exponentialinclines or declines, and widths from 0.1 to 5 ms with a current rangefrom 0 to 50 mA. A frequency from 2 to 6 Hz appears to be the mostpreferred and is very efficient.

Further included is a harness for fixing the device to a particular siteand a power supply. Proper placement of electrostimulation electrodes iscrucial for the efficiency of the entire method and for eliminating therisk of reduced efficiency of the method due to improper handling of theelectrode. The role of the fixing element 5 is to ensure repeatedattachment of the electrodes to the same electrostimulation site. To fixthe position of the electrode, a special harness is used which can usethe shape of a human body as a fixation point to create a shape that ispermanently adapted to the patient and ensures equal conditions for eachstimulation session.

Another embodiment of the electrode is represented by an embodiment witha conductive magnet. This example of a geometrical arrangement of activecomponents is shown in FIG. 1 and FIG. 2, wherein it includes adiamagnetic wedge 10, the main magnet 11, and the pole piece 4. Thesecomponents provide increased penetration depth of the electric currentflowing between the diamagnetic wedge 10 and the passive conductivecontact 12, even at low stimulation currents. They are, due to theirconfiguration, capable of linearizing and concentrating parabolicelectric field lines in an axial direction around the axis of the mainmagnet 11. This results in an ion channel, limited in the diameter anddirection of ion movement by the magnetic field. Thus, as carriers ofelectric charge into the intercellular spaces, the ions move alongtrajectories determined by magnetic field lines. The diamagnetic wedge10 has two functions. It diverts magnetic field lines from the axis ofthe main magnet 11 and provides electrical connection with the skin. Inthis example, the diamagnetic wedge 10 is made of copper and is in theshape of a cylinder, which is rounded at the end adjacent to the tissuefor better contact with the skin and for maximum possible patientcomfort. As is evident from FIG. 2, the diamagnetic wedge 10 ispositioned so that it is completely or at least substantially surroundedby the magnetic field of the main magnet 11. In order to perform itsfunction while being easy to maintain, it is further covered with alayer of gold or other non-toxic and inert material conductingelectricity well. The outer casing and the base of the main magnet 11away from the skin are preferably surrounded by the pole piece 4 made ofdiamagnetic material. The diamagnetic wedge 10 on the side away from theskin is connected to the main magnet 11 by means of a conductiveadhesive or other conductive connection, and, in addition to the aboveeffects, it also prevents a so-called magnetic short circuit on the sideof the main magnet 11 oriented towards the skin. In this example, thepassive conductive contact 12 of the electrode is embodied as a thincopper sheet, which can be gold plated but other diamagnetic materialssuch as silver, gold, bismuth, carbon and electrically conductiveplastics of various compositions can be used as well. In the figures,the passive conductive contact 12 of the electrode is annulus-shaped andis attached to the fixing element 5, thereby being separated from themain magnet 11 by a gap filled with the same insulating material ofwhich the fixing element 5 is made. In other embodiments, however, thepassive conductive contact 12 can be represented by various types ofconductive fabrics or any conductive gel or other conductive materialcommonly used in medicine. In this example, the main magnet 11 isrepresented by a neodymium magnet (NdFeB). The main magnet 11 consistsof one or, in alternative embodiments, of several adjacently arrangedmagnets, and it is oriented with its north pole facing the tissue. Thefixing element 5 and the passive conductive contact 12 of the electrodeare made of materials intended for medical use, which are preferablywaterproof and resistant to frequent sterilization. FIG. 3 shows thefield lines of the electrostimulation device.

A source 9 of voltage is connected to the device between the diamagneticwedge 10 and the passive conductive contact 12. Its output values of thesignal shape and frequency are adjustable. Preferably, frequenciesbetween 0.1 to 100 Hz can be used, and the pulse can be monophasic orbiphasic. Pulse shape can be rectangular, sinusoidal or triangular withexponential inclines or declines and the pulse widths from 0.1 to 5 msor precisely from 1 to 3 ms with an amplitude from 0 to 50 mA. Afrequency between 1 to 15 Hz or, more precisely, 2-7 Hz appears to bethe most preferred and very efficient, but each patient may respondoptimally to a different frequency, so individual adjustment plays animportant role.

Another example is a solution of electrostimulation device which doesnot contain a diamagnetic wedge 10, and is thus suitable also for otherapplications, in addition to those described above, such as forstimulating superficial nerves, improving the absorption of substancesthrough the skin, and for a better supply of nutrients to the skin. Fornon-invasive electrical connection with the tissue, this embodiment seesthe base of the main magnet 11 as being in direct contact with the skin.While in the embodiment illustrated in the figures, on the side facingthe skin, i.e. on the side intended to be applied to the skin, the mainmagnet 11 is adapted for non-invasive electrical connection to thetissue by being equipped with a diamagnetic wedge 10. In thisembodiment, the main magnet 11 is, on the side facing the skin, i.e. onthe side intended to be applied to the skin, adapted for non-invasiveelectrical connection to the tissue by being coated at least on a partof the surface with epoxy resin, conductive plastic, or metal such asnickel, silver, carbon, gold or platinum. This is again a bipolarelectrode, in which the main magnet 11 and the passive conductivecontact 12 are firmly fixed in the fixing element 5 relative to oneanother, which is advantageous for re-stimulation of a particular site.As with the other embodiments, it is possible to enhance the effects ofthe magnetic field using pole piece 4 of the main magnet 11 as describedabove, but its use is not required for all applications.

The fixing element can be made of plastic, rubber, or other materialsuch as a neoprene strap or disposable tape, both of which being gluedtogether or otherwise attached.

The device is not intended for the treatment of stress incontinence butrather for the treatment of urgent types of incontinence or anoveractive bladder (OAB), for example caused by hypersensitivity innerve receptors in the bladder. Due to a malfunction in these receptors,even when the bladder is one-quarter full, the receptors in the brainwill send a false signal leading to an urgent bladder contraction. Thepatient then feels an immediate need to go to the toilet or, in somecases, urine will leak. The purpose of stimulation using the proposeddevice is the transmission of signals through afferent paths to thebrain, which will then restart the receptors in the bladder and thesewill then return to a normal state.

The electrode 15 system and the detector 14 may be connected via thecontrol unit 13, which controls the entire system. As mentioned above,the system may include a single electrode 15, or more electrodes 15.These can include transcutaneous, percutaneous, or implantableelectrodes. Even when using a single electrode 15, it is possible todetermine the optimal frequency; however, for clinically effectivestimulation of the peripheral nerves, may be necessary to use twoelectrodes. The electrode 15 may be connected to the pulse generator 18.The latter can be of two types. The generator 18 is either directly apart of the electrode 15, i.e. it is located within the electrode 15, orit is external. An external pulse generator 18 can be located in thecontroller 16 or, in case of implantable electrodes 15, it remotelypowers the stimulator.

The detector 14 consists of a sensor 17. In the embodiment of thepresent disclosure, the sensor 17 is an optical sensor 17. The opticalsensor 17 can have several embodiments, but most preferably it is anoptical barrier. An optical sensor 17 assembly is shown in detail inFIG. 6 and is described below in the description of the presentdisclosure. In general, the optical barrier may include a transmitterand a receiver. The transmitter may include a generator 18, an amplifier19 and an infrared diode 20 with the optics. The generator 18 may be setto a frequency of 38 kHz. The receiver may include a diaphragm 21, aconverging lens 22, an infrared filter 23, a preamplifier 24, afrequency filter 25, a demodulator 26, a level converter 27 and aprogrammable retarder 28. The frequency filter 25 may be set to 38 kHz.The following parts can be implemented as one component: converging lens22, infrared filter 23, preamplifier 24, filter 25 and frequencydemodulator 26. In this system of transmitter and receiver, the foot 31may be located between the transmitter output and the receiver input.Other types of optical barriers, such as a reflection optical barrier,are not excluded by the present disclosure. When using a reflectionoptical barrier, the optical sensor 17 can consist of one sensor 17 ormore optical sensors 17 variously spaced on the detector 14. Eachoptical sensor 17 of the reflection optical barrier is a transmitter anda receiver at the same time. This makes it possible to detect an object,which gets into the vicinity of said sensor 17. The first advantage ofan embodiment with multiple optical sensors 17 is that the detector 14does not need to be set up by the operator as precisely for the patientas when using only one sensor 17. Another advantage is that moredetailed information regarding movement is received from several sensors17, which can be further processed by the control unit 13 in detail. Ingeneral, the use of an optical sensor 17 is advantageous in terms ofsimplicity of use because the sensor 17 detects objects with goodaccuracy even when the distance from the sensor 17 can vary each time bya few centimeters. These optical sensors 17 are based on thetransmission of light in the infrared or other spectrum. The sensors 17may also be supplemented with a polarizing filter. In addition to astandard infrared sensor 17, a camera can also be used as an opticalsensor 17. The camera may include a CCD or CMOS camera with sufficientresolution. Further, the optical sensors 17 can be configured tofunction without modulation of the signal, with modulation of the signalfor increased resistance to overloading the optical barrier by ambientlight, or in the infrared region with modulation of signal for increasedresistance to overloading the optical barrier by ambient light.

In one possible configuration, the sensors 17 can be arranged one afteranother. The sensors 17 are placed on the holder, via which they arefirmly attached to the rest of the structure. The holder with thesensors 17 can be adjusted by means of a tightening or locking element.Then the whole system records the movements of the lower limbs, whichare in its vicinity.

In an alternative embodiment, the sensor 17 is used as an accelerometer,which is attached to the patient's body. The use of an accelerometer ismore user-friendly than other sensors. The accelerometer can be attachedto the patient's body using a band to which the accelerometer canpossibly be incorporated into. Further, the accelerometer is capable ofdetecting small changes in position. The accelerometer is attached to apart of the leg and the movements resulting from the stimulation aremeasured by the accelerometer. In an alternative embodiment, capacitive,inductive, thermal, magnetic or ultrasonic sensors 17, direct use of anelectromyograph may be used. The disadvantage, compared to opticalsensors 17, is the smaller distance at which the sensor 17 can detect anobject. An example of an ultrasonic sensor 17 is shown in FIG. 7. Such asensor 17 includes a generator 18 of 50 kHz, an exciter 29, a primarypiezo element 30 and a secondary piezo element 32 at a resonancefrequency of 50 kHz, an amplifier 33, a frequency filter 34 of 50 kHz, ademodulator 26, a level converter 27 and a programmable retarder 28. Inthe case of the sensor 17, the limb 31 is located between the first andthe second piezo elements.

The advantage of the sensor 17 providing a digital signal is also thatthe analog sensors 17 can record the movements induced by the deviceonly via a contact. When recording the induced movements, the contactsensors 17 do not provide a high-quality information, because theynaturally interfere with the observed phenomenon. In some cases itresults in an echo within the sensor 17 caused by multiple recording ofthe same movement. Ultimately, this leads to poor detection quality anderrant determination of improper frequency stimulation, or a differentcharacteristic of voltage for stimulation. Moreover, mechanical sensors17 also need additional components to provide a clear, noise-freesignal.

The contactless sensors 17 or the accelerometer can be used without anymodification between patients. For example, when measuring the inducedspasmodic movement of the feet, the measurement may be individuallycustomized to the patient. The feet and physiology of the movements aredifferent for each patient. When using analog sensors 17, suchcustomization is performed mostly by mechanical/manual re-setting of thesensor 17. This requires technical skill on the part of the operator,usually a doctor. As a result, treatment duration and risk of incorrectrecording by the sensor 17 are increased.

For proper treatment efficiency, the sensor 17 may be capable of sendingthe information related to frequency and preferably also otherinformation related to the patient's body motion, such as range ofmotion or speed. Misuse of the sensors 17, usually contact sensors, aswell as directly switching the stimulation of the patient, constitute asignificant risk and, due to their error rates, do not result in propertherapy. They do not provide any information about frequency or otherparameters, such as range of motion or speed, but they directly affectthe activity of the electrode 15. If the system is operating withinformation on the frequency of movement of a part of the patient'sbody, it can be software-configured to various configurations and canprocess the information differently. This, inter alia, also providesother advantages, which are described further below. In order to sendthe information on movement frequency, the control unit 13 may beprovided with digital information. Such a device as per the presentdisclosure, can be realized in two ways. Either when the direct outputfrom the sensor is 17 is digital, or when the analog output may beconnected to the A/D converter, which converts the analog signal to adigital one and sends it on to the control unit 13.

With a digital signal from the sensors 17, the issue of adapting themeasurement for each patient does not arise. All the situations in thiscase are encompassed in the setup of the control unit 13, which takesindividuality into account in advance, and the output from the sensors17 is processed so that it gives the relevant information without anymechanical re-setting of the detector 14. This applies to both thecontactless sensors 17 and the accelerometer, which can be attached tothe foot 31.

The sensor 17 for detecting movement of the stimulated limb sends theinformation to the control unit 13. Here, the information is processedfor further use. The control unit 13 uses the information to directlycontrol the electrodes 15 attached to the patient as feedback foreffective neuromodulation of peripheral nerves. The induced movements ofthe legs provide clinical information that the set frequency ofstimulation current is correct. Thus, the control unit 13 is guided toread the frequency spectrum between the preset limit values. Thesevalues are already factory-set, and they are 1 Hz and 100 Hz. Thecontrol unit 13 controls the electrodes 15 in two phases. These phasesare the recognition phase and the therapeutic phase. In the recognitionphase, the device of the present disclosure searches for an idealfrequency or other parameters of the course of current for theindividual patient based on the feedback from the sensor 17. The controlunit 13 system includes the set rules, defining at what point thefrequency of neuromodulation is considered optimum for the patient.Ideally, it is possible to detect each stimulus as a twitch. If thecontrol unit 13 recognizes the ideal frequency, it is switched to atherapeutic regime. In this mode, the control unit 13 maintains thedetected frequency, thus leading to stimulation of the peripheral nerveswithout further changes. This phase can typically take 30 minutes. Insome cases, for sufficient efficiency of the clinical procedure, thismay take only about two minutes. The control unit 13 can be set toinclude such a condition that once the ideal positive feedback linkagefrom the sensors 17 disappears, the control unit 13 is switched back tothe first recognition phase, and it sets the neighboring frequencies toinitially identified frequencies.

In addition to frequency, the control unit 13 may set other parametersof the pulse as well. One of them is the pulse length, which is between0.1 and 10 ms. Another factor controlled by the control unit 13 is pulseshape. The control unit 13 may also set the voltage polarity rangingfrom positive to negative. Unlike the approach of stimulation by DC, thebiphasic current does not cause electrolysis of tissue, and electrolysispresents a problem for sensitive patients, as it potentially leads toskin problems (irritation of skin, infection). The control unit 13 maybe set in such a way that it calculates the optimum flow of the pulsecurrent x with opposite polarity in order to cancel the effect ofelectrolysis. This mechanism is also known under the term“charge-balanced pulse”. This feature makes the device safer.

In one aspect, the control unit 13 may set the flow of pulse rounds orpulse bursts. This is, for example, 20 pulses applied over a very shorttime. In terms of a longer time interval, these pulse bursts appear as asingle pulse of an irregular shape.

For the above-described pulse setting, a control unit 13 may commandthese parameters is required. As an input for the specific setting, thecontrol unit 13 uses the information from the controller 16 and theinformation on frequency of limb movement from the sensor 17.

Clinical studies have revealed that, for effective treatment, it isnecessary to repeat the therapy in a patient suffering from incontinenceroughly five times before permanent improvement can be achieved. Thisrequires the patient to be subjected to therapy with time breaks whileinevitably passing through both the recognition and the therapeuticphases again; therefore, the control unit 13 includes a memory unitwhere the staff can store data for a single patient, includinginformation relating to at least one identified ideal parameter for agiven patient. The memory of the present disclosure can be any kind ofdata storage, either a local or remote one. These storage devicesinclude HDD and SSD hard drives, flash memories, memory cards, RAMdevices, CDs, DVDs, Blu-ray™ discs, etc. The remote storage unitsinclude the ones that are accessible only by connecting the device to alocal network or the internet, GSM, such as cloud storage. Localnetwork, internet or GSM can all be understood as a network service. Thenetwork may by created also by a number of presented neuromodulationdevices, wherein the first of the neuromodulation devices is connectedto remote storage, and the others are connected to this neuromodulationdevice. The indirect connection of other neuromodulation devicesconnected to the remote storage is preferably wireless. The otherneuromodulation devices communicate with the remote storage unit throughthe first neuromodulation device. The first neuromodulation device thenredirects the data from the remote storage unit to the otherneuromodulation devices connected to the first neuromodulation device asper the identification part of the communicated data.

The stored information about the patient may effectively reduce the timerequired for performing the procedure, and it can also serve asadditional home therapy. In some cases, the patient may buy theelectrodes 15 intended for domestic use for themselves, allowing thepatient or a family member to apply them. This type of device also mayhave a control unit 13 which can use the stored information on theidentified stimulation parameter and adjust the therapy accordingly. Theentry of this information to the device depends on the selected storagemethod, which is not particularly limited by the present disclosure. Ina preferred embodiment, it can be, for example, an SD memory card whichis inserted into the device in the doctor's office to identify the idealstimulation parameter and also into the device for home use, where theproper therapeutic settings are as per the identified stimulationparameter. In another preferred embodiment, the selected storage devicecan be e.g. cloud memory. The stimulation parameter can be enteredthrough the device to the cloud storage and made accessible at thedoctor's office or in home therapy by the same or any other device. Thecloud storage and the stimulation parameter entered thereto may also beaccessible through a computer, tablet, mobile phone or other electronicdevice connected to cloud storage.

In addition to reducing the duration of therapy, storing patient datahas other advantages.

Thanks to the determination of individual stimulation parameters, thereis no need to store this information in another patient file. On thepatient's next visit, it is only necessary to recall the informationautomatically from the system with no search being necessary. This alsoprevents a possible error arising from poor handwriting. An incorrectlyset parameter does not lead to improvement of the patient's condition.The system comprising such information can be further enhanced byincluding the statistics that are directly related to the use of thedevice. In addition to information on a particular frequency, the systemstores other parameters affecting the pulses described above, such asthe polarity of pulses, their length, shape, and others. Thesestatistics are also saved to memory where the therapeutic information isavailable for a particular patient. Then, the amount invoiced to thepatient is always determined correctly and fairly. The same applies tothe amount invoiced to the office by the suppliers in cases when thedevice in the office is charged according to the number of treatmentsperformed. It is also possible to work with such information as ahigh-quality source for producing such statistics, which can then beused both for clinical purposes, making it possible to predict theimprovement in the patient's condition in the future on the basis of therecorded treatment. Furthermore, these statistics are useful fordetermining the usability of the device, calculating the avoided costsassociated with alternative treatments, calculating service intervals,and so on.

The control unit 13 of the present disclosure can be unitary, or thedevice can include several control units 13, e.g., one for the detector14 and another for controlling the electrodes 15. If the device involvesseveral control units 13, these units are equipped with communicationprotocols for continuous information exchange. As a part of thetherapeutic device, the control unit 13 also serves as a decision-makingactor instead of the doctor. In analogue systems, it was necessary thatthe doctor directly set the parameters depending on the observation ofinduced movements or depending on the sensor 17 output for same. Thisleads to lower therapeutic efficiency.

The advantage of sending the movement frequency information from thesensor 17 to the control electronics is increasing the safety andefficiency of the product. With mechanical sensors 17 connected to theelectronics, which use only the amplified signal from the sensor 17 asan excitation signal for stimulation, a potentially dangerous situationcan arise. Due to higher requirements for medical devices, such anapproach is not feasible in clinical conditions; therefore, a device maycomprise a control unit 13 with included commands for varioussituations, thus ensuring an increased security. These commands can be apart of the software or firmware of the control unit 13 depending on itstechnical level. The mechanical sensors 17 are also prone to errorconditions. They represent a high risk, specifically in cases in whichthe recording is used as input for stimulation by the electric current.These error conditions can lead to muscle spasm or, worse, to localburns to the patient at the site of the electrode 15. The electronicsable to ensure greater security may require the connection of sensors 17providing digital information. Using a mechanical sensor 17 and safeelectronics would require another link between the sensor 17 and thecontrol unit 13, which would increase the total price of the device aswell as a possible increased failure rate and inaccuracy by addinganother element to the system.

The device may also involve a controller 16. In general, the controller16 represents user input for controlling the control unit 13, and thisinput can take various shapes and forms. The controller 16 may comprisethe control unit 13 described above. In alternative aspects, the controlunit 13 may be located outside the controller 16. The controller 16 maybe part of the structure of the entire device but does not need to befixed firmly. The controller 16 can be loosely attached to thestructure, but it can be lockable with respect to the support structurein at least one position. In one aspect, the controller 16 may involve adisplay device and a button. The button connected to the controller 16can be a multistep one, enabling more than one instruction to be givendepending on the movement of the controller 16 chosen by the operator.The display device may be used for transferring the information to theoperator. After beginning therapy, the display device can show theinstructions for using the device, so that the therapy is as effectiveas possible. These can be in the form of a sequence of instructions thatare shown on the display device one by one by the operators clicking onthe button of the controller 16. The displayed information may becontrolled by the control unit 13 of the device.

The method of treatment of incontinence using the neuromodulation devicedescribed above and also other similar neuromodulation devices isfurther disclosed. Symptoms of an overactive bladder are, according tothe present disclosure, treated using a neuromodulation devicecomprising at least two active electrodes capable of generatingelectrical pulses. The first step of the present disclosure is attachingfirst one active electrode to a patient's leg and attaching a secondactive electrode to any of the patient's legs. Attaching of any of theactive electrodes is to be understood as attaching a removable electrodeto the patient's skin (transcutaneous) or attaching any of the activeelectrodes to the patient's body by penetrating the patient's skinpercutaneously or attaching any of the active electrodes by implantingthe active electrodes into the patient's leg for long-term implantation.Further, the first electrical pulses are generated in the first activeelectrode into the patient's body and the second electrical pulses aregenerated in the second active electrode into the patient's body.Further, the present disclosure may involve a step of setting a flow ofthe current of the pulses. The present disclosure may further include astep of synchronizing the timing of each pulse.

After generating the electrical pulses, the pulses may be delivered tothe branches of the patient's nerves, thus stimulating the nerves anddelivering the stimulus in the form of the pulse to the target area. Thetarget area is the sacral plexus or the sciatic nerve. In one aspect,the first electrical and second electrical pulses are generated inturns, thus the interval of the electrical pulses can be as follows: thefirst electrical pulse, then the second electrical pulse, then the firstelectrical pulse, and so on. Alternatively, the interval can be asfollows: the second electrical pulse, the first electrical pulse, thesecond electrical pulse and so on. In some of the preferred embodiments,the electrical pulses can be generated simultaneously at the same timeor can be generated independently, such as the first electrical pulse,the second electrical pulse, the first electrical pulse, and so on. Inone aspect one of the first electrical pulses and one of the secondelectrical pulses reach the target area simultaneously. The simultaneouseffect of two independently generated electrical pulses may bring highereffectivity of the treatment compared to the prior art. According to thepresent disclosure, more than two active electrodes may be used, whereina third active electrode may be attached to the patient's body, forexample, a third active electrode capable of generating electricalpulses may be attached to either of the patient's legs. The thirdelectrode may generate the third electrical pulses, which may besynchronized so that one of the third electrical pulses, one of thesecond electrical pulses and one of the first electrical pulses reachthe target area simultaneously. Similarly, more active electrodes can beattached to the patient's body in order to generate electrical pulses.

The active electrode be an electrode such as the electrode describedpreviously and illustrated in FIG. 4, comprising a magnet 3, a polepiece 4, the first pole 1 of the electrode and the second pole 8 of theelectrode. Another embodiment of the electrode is the electrode shown inFIG. 1 and described previously. Preferably, the electrodes used aretranscutaneous as in the two electrodes described previously or anotherembodiments of transcutaneous electrodes. Transcutaneous electrodes areadvantageous mostly because their usage does not require invasiveprocedures. In yet another embodiment of the disclosure, thepercutaneous electrodes capable of penetrating the patient's skin andcapable of generating electrical pulses are used as active electrodes.In yet another example of the embodiment of the present disclosure, theelectrodes may be long-term implantation electrodes. The electrodes, forexample, the first electrode, the second electrode and the otherelectrodes can involve one or more conductors. The active electrodes ofany type are characterized in that they may be capable of generatingelectrical pulses or capable of delivering the electrical pulsesgenerated by a pulse generator to the body of the patient. The generatoris either directly a part of the electrode, i.e. it is located withinthe electrode, or it is external. An external pulse generator can belocated in the controller or, in case of implantable electrodes, itremotely powers the stimulator. In the embodiment of the presentdisclosure using electrodes for long-term implantation, the electrodescan be inductively “charged”. In this embodiment, the external pulsegenerator is connected to an inductor, and the electrical pulses aregenerated in the electrodes by the magnetic field created by theinductor.

In an aspect of the present disclosure, the active electrodes areattached in proximity to the branches of a peripheral nerve so that theelectrical pulses generated by any of the electrodes are capable ofdelivering electrical pulses to the nerve. When using transcutaneouselectrodes, the electrodes are placed, for example, in the area of theknee so that the surface of the electrodes is facing a branch ofperipheral nerve through the tissue. When using the percutaneouselectrodes or the electrodes for long term implantation, the electrodesmay be placed within the vicinity of the branches of a peripheral nervewhile not directly touching the branches of a peripheral nerve.

In the method of the present disclosure, any of the following nerves arestimulated: the lumbosacral plexus, sciatic nerve, common peroneal,tibial nerve, pudendal nerve, superior gluteal nerve, inferior glutealnerve, posterior cutaneous femoral nerve, obturator internus nerve,piriformis, quadratus femoris nerve, plantar nerve or coccygeal nerve.Most advantageous in treatment of the symptoms of an overactive bladderis stimulation of the peroneal nerve, pudendal nerve, tibial nerve orany combination of the aforementioned nerves. Stimulation of the nervesis achieved by sending the electrical pulses through the branches ofperipheral nerves and distributing the nerve stimulus to the target areaof, for example, other sacral plexus or the sciatic nerve. Theelectrodes can be, as per the present disclosure, attached to thepatient so that the first active electrode is attached to the firstbranch of a sciatic nerve and the second active electrode is attached toa second branch of the sciatic nerve; in other embodiments, multipleactive electrodes can be attached to multiple branches of the sciatic orother nerves in order to stimulate the target area. The activeelectrodes can be both attached to the same leg or be each attached to adifferent leg of the patient. In some cases, attaching the activeelectrodes to different legs of the patient increases the healingeffect, as the simultaneous effect of stimulation is more easilyachievable.

In the method of treatment, there is further a grounding conductorplaced on the patient's body. Preferably the grounding conductor is inthe form of a pad. The grounding pad can be placed anywhere on thepatient's body. As per the present disclosure, the grounding conductormay be placed on the patient's suprapubic, hypogastric or sacral area.By placing the grounding conductor in said areas, the healing effect ofthe method increases. For the grounding conductor attracts the first andsecond electrical pulses, thus the target area is reached moreeffectively. Additionally, the grounding conductor can be configured forgenerating the electrical pulses, wherein in some embodiments, thegrounding conductor generates positive electrical pulses and thus has acalming effect on the patient's bladder.

In the presented method, a variety of electrical pulses may be used. Inone aspect of the present disclosure, the following limitations may beused for the electrical pulses. The frequency of the first electricalpulses, second electrical pulses or, in some embodiments, the pulsesgenerated by a third, a fourth or other electrodes is between 0.1 Hz and100 Hz. Pulse width of said pulses is between 0.1 ms and 5 ms, and thecurrent of said pulses is between 0 mA and 250 mA, with the voltage ofsaid pulses being between 0 V and 90 V. As every patient reacts totreatment differently because of different physiology, the parameters ofpulses therefore vary for individual patients. In one of the preferredembodiments, the parameters vary over the course of the treatment of thepatient according to the patient's response to the treatment. Adjustmentof the parameters can be made by the person providing the treatment orautomatically by means of a control unit having a suitable algorithm.For most patients, the best treatment results may be achieved by usingthe following parameters of said pulses: a voltage frequency of between2.5 Hz and 60 Hz and a pulse width between 0.1 ms and 2.5 ms. TheCurrent of said electrical pulses also depends on the type of theelectrode used and its surface. Using electrodes which have an activesurface of more than 0.3100 square inch (2 cm²) achieves the mosteffective treatment results using a current of the said electricalpulses between 15 mA and 250 mA. Using electrodes which have an activesurface of between 0.0775 square inch (0.5 cm²) and 0.3100 square inch(2 cm²) achieves the most effective treatment results using a current ofsaid pulses between 0 mA and 15 mA. Using electrodes which have active asurface of less than 0.0775 square inch (0.5 cm²) achieves the mosteffective treatment results using current of said pulses between 0 mAand 5 mA. The shape of said electrical pulses may be also important forimproving treatment results; most effective is, as per the presentdisclosure, a shape of the electrical pulses having a steep incline.Therefore, an advantageous shapes of said electrical pulses may besubstantially rectangular or substantially of the shape of righttriangle. Said pulses may be monophasic or biphasic.

In one aspect of the present disclosure, the flow of current is setcorrespondingly to a biofeedback signal. Such a biofeedback signal canbe visual or determined means of a sensor. Typically, the biofeedbackcan be the form of twitching in the patient's lower limb.

In order to ensure highly effective treatment, said pulses may beapplied to the patient's body in a synchronized manner so that nervestimuli generated in the patient's nervous system by the firstelectrical pulses and the nerve stimuli generated in the patient's bodyby the second electrical pulses reach the target area simultaneously sothat the nerve stimulus generated in the patient's nervous system by anyof the first electrical pulses and the nerve stimulus generated in thepatient's nervous system by any of the second electrical pulses reachthe target area at the same time. In other advantageous aspect of thepresent disclosure, nerve stimuluses may be also generated in thepatient's nervous system by tertiary electrical pulses and/or by anyfurther electrical pulses generated by any other active electrodes,which are synchronized. Synchronization of the pulses may provide moreeffective treatment, so that quicker recovery and shorter treatmentsessions are preferably achieved. Synchronization of the pulses can be,according to one aspect, achieved by means of an algorithm stored in thememory of the control unit, wherein the algorithm sets the timing of thegeneration of the electrical pulses. Multiple inputs can be acquired bythe algorithm, such as data from a sensor monitoring biofeedback,duration, and parameters of the first electrical pulses, secondelectrical pulses and any other electrical pulses, data of the previoustreatment sessions of the patient and other relevant data.

A method of positioning the electrodes is further disclosed, wherein,firstly, an active electrode is attached to the patient's body.Preferably but not exclusively, the attachment is made in the knee areaof the patient. After the attachment, electrical pulses are generated inthe active electrode. After and/or during the generation of theseelectrical pulses, the reflex movement of the patient's body part ismonitored. The reflex movements of the patient's body part are, forexample, twitches of the lower limb, and such monitoring can be doneeither visually or by sensor. The monitored reflex movement, such as thetwitching of the patient's lower limb, is thereafter, or during themonitoring, compared to the expected reflex movement. Determination canbe made by the person or by an algorithm. For example, the algorithmcompares the data acquired by the sensor and compares it to the datastored in the memory of the control unit. For example, such data can berepresented by the number of twitches of the limb per period of time. Incase the number of twitches of the lower limb is the same or higher thanthe number of twitches of the lower limb stored in the memory of thecontrol unit, the reflex movement of the patient's body is considered tobe sufficient. Subsequently, the control unit can visually, acousticallyor tactually inform the person of the achievement of sufficient orinsufficient reflex movement of the patient's body part. If the reflexmovement of at least part of the patient's body is insufficient, theelectrode is relocated on the patient's body and the steps are repeated.This method enables the user to precisely position the active electrodein order to stimulate the nerves of the patient more effectively.

The method described above is also suitable for treatment of othermedical conditions, such as and not limited to, painful bladdersyndrome, fecal incontinence or Low Urinary Tract Dysfunction.

One of the possible illustrative embodiments of the present method isfurther disclosed. For purpose of this illustrative embodiment, theactive electrode is of a transcutaneous type and the neuromodulationdevice involves two active electrodes, a grounding electrode, a memoryunit, a control unit, a sensor for monitoring the reflex movement of atleast a part of the patient's body, such as an accelerometercommunicatively coupled to the control unit, and a controller forcontrolling the neuromodulation device. A person, such as the patient orthe patient's physician, attaches the active electrode onto thepatient's body. The person may attache the first electrode, for example,in the knee area of the first leg in such manner that the firstelectrode's active surface faces approximately the peripheral nerve. Theperson may further places the grounding electrode, preferably in theform of a pad, on patient's suprapubic, hypogastric or sacral area. Theperson may further place the accelerometer on the patient's leg. Thethen person may activate the device to start generating the firstelectrical pulses. In this illustrative embodiment, the neuromodulationdevice informs the patient of the sufficiency of the induced movementsof the part of the patient's body, in this embodiment, the leg. Theinitial pulses may be generated with parameters according to theprevious treatment sessions of the patient; in cases in which theparameters are not stored in memory, the control unit sets theparameters based on pre-set default parameters. The parameters of thefirst electrical pulses may be any of the following frequency intervals:between 0.1 Hz and 100 Hz, a pulse width of between 0.1 ms and 5 ms, acurrent of between 0 mA and 250 mA, with a voltage between 0 V and 90 V.The control unit may generate the first electrical pulses and changesthe parameters of the pulses. In case, after a predefined number offirst electrical pulses and number of variations of parameter values,the movement of the leg being monitored by the accelerometer isinsufficient, the device informs the person, for example, audibly orvisually in another manner. For example, by means of a red light, a textdisplay or by means of a predefined sound. The person may thenreposition the first active electrode and repeats the process until themovement of the leg is sufficient. The neuromodulation device may informthe person of sufficient reflex movement either audibly or visually, forexample, by means of, say, a green light or by a text display. Once thefirst active electrode is precisely attached, the person attaches thesecond active electrode to the patient's body. In this illustrativeembodiment, the second active electrode may be attached to the patient'ssecond leg in the knee area in the same way as the first electrode. Thesecond electrode may be further precisely positioned using substantiallythe same steps as in the foregoing precise positioning of the firstactive electrode. As both of the active electrodes are preciselypositioned to the patient's body, the first electrical pulses and thesecond electrical pulses are directed to the patient's body, stimulatingthe target area. The flow of the pulse current may be set manually or bymeans of the control unit. Preferably, in this illustrative aspect, theparameters of the first electrical pulses and the second electricalpulses are set via the control unit. In this aspect, the synchronizationof the pulses may be achieved by means of the control unit, for example,on the basis of biofeedback, such as the reflex movement of thepatient's leg. The parameters of the pulses might vary during thetreatment session, depending upon the patient's biofeedback. Thetreatment session takes typically 15 to 45 minutes.

In this illustrative aspect information regarding the treatment sessioncan be collected and stored in an adjacent or remote memory storagedevice for further use.

A method of collecting information about usage of a medical device, suchas the neuromodulation device described above, other similarneuromodulation devices or other medical devices are further disclosed.The medical device may comprise a memory and a control unit. Such saidmedical devices can be, for example, therapeutic medical devices,surgical devices or diagnostic medical devices. The method may involvethe first step, where information from the control unit is collected,after that the collected information is sent from the control unit tomemory. After sending the information to the memory the information maybe stored in a database. The information stored in the database may belater called out from the database, for example, by using a controlpanel, computer or other electronic device with access to the database.The control unit can communicate with the memory using a variety ofcommunication protocols, such as but not limited to GSM, Bluetooth,radio frequency, infrared communication, LAN, USB and a wirelessinternet connection. In one aspect, the memory can be remote from themedical device, such being stored on the cloud, remote server or remotedata storage. In one aspect, an identification number may be assigned tothe medical device and/or to a patient. In one aspect, theidentification number is assigned also to the particular information.According to the identification number, the memory can assign paymentand suitable treatment parameters for the patient. For example, using amedical device and a memory of a remote type, any medical device cancall information about the patient and adjust treatment parametersaccording to the patient's needs; payment can also be directedaccordingly to the patient's identification number. Accessing the remotememory of the medical device can be achieved by connecting to remotememory, such as the cloud, or by connecting to the memory adjacent tothe medical device through a connection established in between themedical devices. In one aspect, several medical devices can create acommunication network, with one of the medical devices being able toconnect to the memory and other medical devices being able to access thememory by communicating with the said one medical device.

In one aspect, the information stored in the database may be sent to thepatient's physician and/or to the patient's electronic medical chart.Sending the information automatically or upon the patient's requestthrough the device is convenient for the patient and patient'sphysician, especially during home treatment applied by the patienthimself. The data stored in the database can also be used for evaluatingthe progress of each user. Also, the information stored in the databasecan provide a long-term statistical record of the usage of the medicaldevices. Such feedback is important for the manufacturer to fine-tunethe device accordingly and to have sufficient data for development ofthe devices. Information used for such long-term statistics, forexample, data on usage of neuromodulation devices, may be any thefollowing: the data on the number of users, data on the intensity ofusage, on the number of payments, on current intensity or on frequencyof pulses.

-   -   Further, the disclosure comprises examples according to the        following clauses:    -   Clause 1. A neuromodulation device for stimulating peripheral        nerves comprising: a memory, at least one electrode configured        to be attached to a patient's body for the generation of        electrical pulses, a control unit connected by means of an        electrode configured for setting at least one electrode pulse        parameter, a neuromodulation response detector connected to a        control unit configured to send information on the frequency of        movement of at least a part of the patient's body to the control        unit, wherein the control unit is configured to automatically        set the flow of the current of the electrode pulses, depending        on information on the frequency of movement of at least a part        of the patient's body.    -   Clause 2. A neuromodulation device according to clause 1,        wherein the information of the frequency is obtained from the        detector of response to neuromodulation, or from the memory.    -   Clause 3. A neuromodulation device according to clause 1,        wherein the detector involves an accelerometer.    -   Clause 4. A neuromodulation device according to clause 1,        wherein the detector involves at least one capacitive,        inductive, thermal, infrared, flow, ultrasound, magnetic or        optical sensor.    -   Clause 5. A neuromodulation device according to clause 1,        wherein the detector is an electromyograph.    -   Clause 6. A neuromodulation device according to clause 1,        wherein the detector involves at least two sensors.    -   Clause 7. A neuromodulation device according to clause 1,        wherein the memory is an internal memory of the control unit.    -   Clause 8. A neuromodulation device according to clause 1,        wherein the memory is represented by at least one from the group        consisting of a HDD disk, SSD disc, flash memory, memory card,        RAM, CD, or DVD.    -   Clause 9. A neuromodulation device according to clause 1,        wherein the memory is a remote storage unit available through a        network service.    -   Clause 10. A neuromodulation device according to clause 9,        wherein the remote memory storage is configured to be accessed        through another neuromodulation device connected to the network        service.    -   Clause 11. A neuromodulation device according to clause 1,        wherein the control unit is configured to change the frequency        of the electrode pulses until the frequency of the electrode        pulses substantially equals the frequency of the recorded        movements of at least a part of the patient's body.    -   Clause 12. A neuromodulation device according to clause 1,        wherein the control unit is configured to change the flow of the        current of pulses until an optimum frequency of the recorded        movements of at least a part of the patient's body is reached.    -   Clause 13. A neuromodulation device according to clause 1,        wherein the control unit is configured to set the frequency of        pulses in the range between 1 and 100 Hz.    -   Clause 14. A neuromodulation device according to clause 1,        wherein the control unit is configured to set the length of the        pulse in the range between 0.1 and 10 ms.    -   Clause 15. A neuromodulation device according to clause 1,        wherein the control unit is configured to set the pulse shape to        any shape of the group consisting of rectangular and right        triangle.    -   Clause 16. A neuromodulation device according to clause 1,        wherein the control unit is configured to set the voltage        polarity ranging from positive to negative.    -   Clause 17. A neuromodulation device according to clause 1,        wherein the control unit consists of several control units.    -   Clause 18. A neuromodulation device according to clause 1,        further comprising a controller connected to the control unit        configured for acquiring user input.    -   Clause 19. A neuromodulation device according to clause 18,        wherein the control unit is a part of the controller.    -   Clause 20. A neuromodulation device according to clause 18,        wherein the controller includes a display device.    -   Clause 21. A neuromodulation device according to clause 1,        wherein the memory involves a database of patients.    -   Clause 22. A neuromodulation device according to clause 21,        wherein the database contains information on treatment histories        and/or patient's personal data.    -   Clause 23. A neuromodulation device according to clause 22,        wherein the control unit is configured to send the information        from the database to remote storage.    -   Clause 24. A neuromodulation device according to clause 18,        wherein the controller and at least one of the electrodes are a        part of a single unit.    -   Clause 25. A method for neuromodulation treatment of the        symptoms of an overactive bladder in humans using a        neuromodulation device comprising at least two active electrodes        capable of generating electrical pulses, and a control unit,        communicatively coupled to the active electrodes comprising the        steps of: attaching the active electrodes to the patient's body        so that the first active electrode is attached to either of the        patient's legs and the second active electrode is also attached        to either of the patient's legs; generating first electrical        pulses in the first active electrode to the patient's body and        generating second electrical pulses in the second active        electrode to the patient's body; setting a flow of the current        of the pulses; and synchronizing the timing of each pulse.    -   Clause 26. The method of clause 25 wherein the active electrodes        are attached in proximity to branches of a peripheral nerve.    -   Clause 27. The method of clause 26, wherein the neuromodulation        pulses stimulate at least one of the nerves selected from: the        lumbosacral plexus, sciatic nerve, common peroneal nerve, tibial        nerve, pudendal nerve, superior gluteal nerve, inferior gluteal        nerve, posterior cutaneous femoral nerve, obturator internus        nerve, piriformis, quadratus femoris nerve, plantar nerve,        coccygeal nerve.    -   Clause 28. The method of clause 27, wherein the neuromodulation        pulses stimulate any of the nerves, whether the pudendal nerve,        the tibial nerve or the common peroneal, or any combination        thereof.    -   Clause 29. The method of clause 26, wherein the first active        electrode is attached to the first branch of a sciatic nerve and        the second active electrode is attached to another branch of a        sciatic nerve.    -   Clause 30. The method of clause 25, wherein the first active        electrode is attached to the first leg of the patient and the        second active electrode is attached to the other leg of the        patient.    -   Clause 31. The method of clause 25, wherein the first active        electrode is attached to the first leg of the patient and the        second active electrode is attached also to the same leg.    -   Clause 32. The method of clause 25, wherein the said electrodes        are transcutaneous or percutaneous electrodes or electrodes        configured for long-term implantation.    -   Clause 33. The method of clause 25, wherein the first active        electrode is attached to the back of one knee of the patient and        the second active electrode is attached to back of either knee.    -   Clause 34. The method of clause 25, wherein the timing of pulses        is synchronized on the basis of the beginning time of each        pulse.    -   Clause 35. The method of clause 25, wherein the timing of pulses        is synchronized according to the time of delivery of the pulse        from the first active electrode and the time of delivery of the        pulse from another active electrode to the target area.    -   Clause 36. The method of clause 35, wherein the target area is        the sacral plexus or the sciatic nerve.    -   Clause 37. The method of clause 25 further comprising the step        of placing a grounding conductor on the patient's body.    -   Clause 38. The method of clause 37, wherein the said grounding        conductor is placed on the patient's suprapubic or hypogastric        or sacral area.    -   Clause 39. The method of clause 25, wherein the first and the        second electric pulses have a frequency between 0.1 Hz and 100        Hz, a pulse width between 0.1 ms and 5 ms, a current between 0        mA and 250 mA and a voltage between 0 V and 90 V.    -   Clause 40. The method of clause 39, wherein the first and second        electric pulses have frequency between 2.5 Hz and 60 Hz.    -   Clause 41. The method of clause 39, wherein the first and second        electric pulses pulse width is between 0.1 ms and 2.5 ms.    -   Clause 42. The method of clause 39, wherein the first and second        electrodes have an active surface of more than 2 cm2 and the        first and second electric pulses have a current between 15 mA        and 250 mA.    -   Clause 43. The method of clause 39, wherein the first and the        second electrodes have an active surface between 0.5 cm2 and 2        cm2 and the first and the second electric pulses have a current        between 0 mA and 15 mA.    -   Clause 44. The method of clause 39, wherein the first and second        electrodes have an active surface of less than 0.5 cm2 and the        first and the second electric pulses have a current between 0 mA        and 5 mA.    -   Clause 45. The method of clause 25, wherein the first and the        second electric pulses have substantially a shape of a rectangle        or a right triangle.    -   Clause 46. The method of clause 25, wherein the first and the        second electric pulse are monophasic or biphasic.    -   Clause 47. The method of clause 25 further comprising a step of        setting a flow of the current corresponding to a biofeedback        signal.    -   Clause 48. The method of clause 25, wherein synchronization of        the pulses is determined on the basis of an algorithm stored in        a memory of the control unit.    -   Clause 49. The method of clause 25 further comprising the step        of precise positioning of the first active electrode and the        second active electrode, comprising: generation of the        electrical pulses after the attachment of any of the active        electrodes; monitoring the reflex movement of at least one part        of the patient's body; determining whether the reflex movement        of the part of patient's body is sufficient; relocating the        active electrode if the reflex movement of at least part of the        patient's body is insufficient; repeating the steps until a        movement of at least one part of the patient's body is        sufficient.    -   Clause 50. A method of collecting information about usage of a        medical device comprising the following steps: collecting        information from a control unit; sending the information from        the control unit to a memory; storing the information in a        database; calling the information from the database.    -   Clause 51. A method of clause 50, wherein the medical device is        at least one of the group consisting of the therapeutic medical        device, surgical medical device or diagnostic medical device.    -   Clause 52. A method of clause 50, wherein the control unit        communicates with the memory using any of the group of means        consisting of GSM, Bluetooth, radio frequency, infrared        communication, LAN, USB and a wireless internet connection.    -   Clause 53. A method of clause 50, further comprising a step of        assigning each of the medical devices and/or a patient and/or        information with an identification number.    -   Clause 54. A method of clause 50, further comprising the steps        of storing the information in an integral memory of a device;        connecting the medical device to another medical device.    -   Clause 55. A method of clause 50, wherein the information        concerns the treatment and involves at least one of the group        consisting of the information on the flow of the current of        pulses, information on the current intensity, information on the        frequency of pulses, information on the treatment duration.    -   Clause 56. A method of clause 50, further comprising the steps        of: evaluating the information stored in the database; using the        information from the database for invoicing.    -   Clause 57. A method of clause 50, further comprising a step of:        using the information stored in the database to send the        information to a patient's physician and/or to the patient's        electronic medical chart.    -   Clause 58. A method of the clause 50, further comprising a step        of using the information stored in the database to automatically        alter the parameters of a treatment or use of the device.

LIST OF REFERENCE SIGNS

-   1—first pole of the electrode-   2—wire-   3—magnet-   4—pole piece-   5—fixing element-   6—nut-   7—adapter-   8—second pole of the electrode-   9—source-   10—diamagnetic wedge-   11—main magnet-   12—passive conductive contact-   13—control unit-   14—detector-   15—electrode-   16—controller-   17—sensor-   18—generator-   19—amplifier-   20—IR diode-   21—diaphragm-   22—converging lens-   23—IR filter-   24—preamplifier-   25—frequency filter-   26—demodulator-   27—level converter-   28—programmable retarder-   29—exciter-   30—first piezo element-   31—foot-   32—second piezo element-   33—amplifier-   34—frequency filter

1. A neuromodulation medical treatment device comprising: a pulsegenerator configured to generate electrical pulses; at least one activeelectrode connected to the pulse generator, wherein the at least oneactive electrode has an electrically conductive surface of less than orequal to 0.3100 square inch and the electrically conductive surface isconfigured to be attached to a patient's skin in a proximity of branchesof peripheral nerves, wherein the at least one active electrode isadapted to stimulate via the electrically conductive surface theperipheral nerves by electrical pulses generated by the pulse generator;a control unit configured to control the pulse generator and set atleast one parameter of generated electrical pulses, wherein the controlunit is configured to adjust the at least one parameter of generatedpulses.
 2. The neuromodulation device according to claim 1, wherein thesize of the electrically conductive surface is comprised between 0.3100square inch and 0.0775 square inch or the size of the electricallyconductive surface is less than 0.0775 square inch.
 3. Theneuromodulation device according to claim 1 further comprising agrounding electrode connected to the pulse generator and configured tobe attached to the patient's skin, wherein the at least one activeelectrode comprises at least two active electrodes and each of the atleast two active electrodes has the electrically conductive surfaceadapted to stimulate the peripheral nerves by electrical pulsesgenerated by the pulse generator.
 4. The neuromodulation deviceaccording to claim 3, wherein the at least two active electrodescomprise a first active electrode configured to be attached to a firstleg of the patient and a second active electrode configured to beattached to a second leg of the patient.
 5. The neuromodulation deviceaccording to claim 4, wherein the electrically conductive surface of thefirst active electrode is configured to be attached in the back of theknee area in proximity of a peroneal and/or tibial nerve of the firstleg and the electrically conductive surface of the second activeelectrode is configured to be attached to the back of the knee area inproximity of a peroneal and/or tibial nerve of the second leg.
 6. Theneuromodulation device according to claim 4, wherein the electricallyconductive surface of the first active electrode is configured to beattached in proximity of a peroneal and/or tibial nerve in the ankleregion of the first leg and the electrically conductive surface of thesecond active electrode is configured to be attached in proximity of aperoneal and/or tibial nerve in the ankle region of the second leg. 7.The neuromodulation device according to claim 4, wherein the controlunit is configured to set voltage and/or current of the generated pulsesand invoke a reflex movement of each of the first and the secondpatient's leg in response to the generated pulses.
 8. Theneuromodulation device according to claim 4, wherein the control unit isconfigured to independently set timings of generated pulses respectivelyto the first and the second active electrodes.
 9. The neuromodulationdevice according to claim 8, wherein the device further comprises adetector connected to the control unit, the detector is configured todetect the invoked reflex movement of each of the first and the secondpatient's leg, wherein the invoked reflex movement is a response to thefirst and/or the second peroneal and/or tibial nerve stimulation, andthe control unit is configured to independently set the timings ofgenerated pulses respectively to the first and the second activeelectrodes so that the invoked reflex movement of the first and thesecond leg is synchronized.
 10. The neuromodulation device according toclaim 1, wherein the pulse generator generates electrical pulses with afrequency comprised between 2.5 Hz and 60 Hz and the electrical pulseshave a pulse width comprised between 0.1 ms and 2.5 ms.
 11. Theneuromodulation device according to claim 1, wherein the pulse generatorgenerates electrical pulses with a frequency comprised between 1 Hz and15 Hz or the pulse generator generates electrical pulses with afrequency comprised between 2 Hz and 6 Hz.
 12. A medical treatmentneuromodulation method comprising: generating electrical pulses by apulse generator; attaching an electrically conductive surface of atleast one active electrode to a patient's skin in a proximity ofbranches of peripheral nerves, wherein the at least one electrode isconnected to the pulse generator and the electrically conductive surfaceis less than or equal to 0.03100 square inch; stimulating via theelectrically conductive surface the peripheral nerves by electricalpulses generated by the pulse generator; controlling by a control unitthe pulse generator and setting at least one parameter of generatedelectrical pulses; and adjusting the at least one parameter of generatedpulses depending on reflexive movements of the patient's body invoked asa response to the stimulation of the peripheral nerves.
 13. The medicaltreatment neuromodulation method according to claim 12, wherein the sizeof the electrically conductive surface is comprised between 0.3100square inch and 0.0775 square inch.
 14. The medical treatmentneuromodulation method according to claim 12, wherein the size of theelectrically conductive surface is less than 0.0775 square inch.
 15. Themedical treatment neuromodulation method according to claim 12, whereinthe at least one active electrode comprises at least two activeelectrodes, wherein the attaching an electrically conductive surface ofthe at least two active electrodes to a patient's skin comprises:attaching the first active electrode to a first patient's legs; andattaching the second active electrode to a second patient's leg.
 16. Themedical treatment neuromodulation method according to claim 15, whereinattaching the first active electrode to a first patient's legs involveattaching the first active electrode to the back of the knee area inproximity of a peroneal and/or tibial nerve of the first leg andattaching the second active electrode involves attaching the secondactive electrode to the back of the knee area in proximity of a peronealand/or tibial nerve of the second leg.
 17. The medical treatmentneuromodulation method according to claim 15, wherein attaching thefirst active electrode to a first patient's legs involve attaching thefirst active electrode to the ankle area in proximity of a peronealand/or tibial nerve of the first leg and attaching the second activeelectrode involves attaching the second active electrode to the anklearea in proximity of a peroneal and/or tibial nerve of the second leg.18. The medical treatment neuromodulation method according to claim 15,the method further comprising: independently adjusting, by the controlunit, timings of generated pulses to respectively the first and thesecond active electrodes so that the invoked reflex movement of thefirst and the second leg is synchronized.
 19. The medical treatmentneuromodulation method according to claim 15, the method furthercomprising: detecting by a detector connected to the control unit theinvoked reflex movement of each of the first and the second patient'sleg.
 20. The medical treatment neuromodulation method according to claim19, the method further comprising: monitoring by the detector theinvoked reflexive movement of each of the first and the second patient'sleg; comparing the monitored visible reflex movement with an expectedvalue of an expected reflex movement and based on the comparisondetermining whether the reflex movement is sufficient.